2010 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Alamance | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Alexander | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Alleghany | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Ashe | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Avery | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Beaufort | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Bertie | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Bladen | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Brunswick | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Cabarrus | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Caldwell | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Carteret | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Caswell | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Catawba | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Chatham | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Chowan | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Columbus | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Cumberland | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Davidson | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Davie | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Duplin | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Durham | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Edgecombe | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Forsyth | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Franklin | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Gaston | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Gates | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Granville | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Greene | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Guilford | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Halifax | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Harnett | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Haywood | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Henderson | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Hertford | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Hoke | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Hyde | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Iredell | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Johnston | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Lee | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Lincoln | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Martin | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Mecklenburg | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Nash | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
New Hanover | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Northampton | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Onslow | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Orange | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Pender | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Perquimans | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Person | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Pitt | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Polk | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Randolph | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Richmond | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Robeson | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Rockingham | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Rowan | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Sampson | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Stanly | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Stokes | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Surry | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Tyrrell | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Wake | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Warren | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Washington | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Watauga | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Wayne | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Wilkes | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Yadkin | $80.90 | $0 | Many Generics | Tier 1 - Generic: $6.00 Tier 2 - Preferred Brand: $35.00 Tier 3 - Non-preferred: $75.00 Tier 4 - Specialty: 33% | n/a Browse Formulary | |||||
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